1. Joe Couto Assistant Professor Jefferson School of Population Health February 5, 2011 Joseph.couto@jefferson.edu

2.  Location: Philadelphia, Pennsylvania  Size: 5,000 students and 7,000 faculty and staff  Health Sciences University containing  Jefferson Medical College  Jefferson College of Graduate Studies  Jefferson School of Health Professions  Jefferson School of Nursing  Jefferson School of Pharmacy  Jefferson School of Population Health

3.  Why a School of Population Health?  Population health was identified as one of FIVE key strategic priorities approved by the TJU Board of Trustees in alignment with the University’s Mission and Vision  Population health is the distribution of health outcomes within a population, the health determinants that influence distribution and the policies and interventions that impact the determinants.  Response to critical health industry needs  Five key graduate-level programs  Master of Public Health  Master of Health Policy  Master of Healthcare Quality and Safety  Master of Chronic Care Management  PhD in Population Health Science

4.  Master of Healthcare Quality and Safety (MS- HQS)  Curriculum includes a focus on:  Organizational Behavior Change  Measurement and Outcomes  Tools and Methods  Clinical Application  MS-HQS Faculty as well as the ambulatory care performance improvement team serve as student resources and mentors

5.  Define patient engagement and activation  Discuss emerging technologies to engage patients  Propose

6.  Patient’s playing a more active role in their care and advocating for…THEMSELVES  Seeks to improve the following areas  Health Literacy  Clinical Decision Making  Self Care  Patient Safety

7.  AMA stated in 1999 that poor health literacy is a “stronger predictor of a person’s health than age, income, employment status, education level and race”  Fundamental to engaging patients  Traditionally printed materials  Evolving onto the web and other technologies  Reliability concerns  Targeting disadvantaged groups  Elderly, minorities, immigrants, low income  Mass media campaigns

8.  Patient decision aids  Training clinicians in communication skills  Coaching and question prompts for patients  American Center for Patient Decisionmaking www.decision.org www.decision.org  Foundation for Informed Medical Decision Making www.informedmedicaldecisions.org www.informedmedicaldecisions.org

9.  Self management education  Self monitoring and self administered treatment  Self help groups and peer support  Patient access to personal medical information  Patient centered telemed and e-health

10.  Information to choose quality providers  Patient involvement in infection control  Joint Commission’s Speak Up TM campaign  Encouraging adherence to treatment regimens  Checking records and care processes  Patient reporting of adverse drug events

11.  Knowledge of condition and complications  Self care knowledge  Knowledge of treatment options and likely outcomes  Comprehension of information  Recall of information

12.  Patients’ satisfaction  Doctor-patient communication  Quality of life  Psychological wellbeing  Self efficacy  Involvement and empowerment of patients

13.  Hospital admission rates  ED admission rates  Length of stay  Number of family medicine visits  Cost effectiveness  Perspective?  Patient costs  Lost productivity

14.  Health related lifestyles  Self care activities  Treatment adherence  Severity of disease or symptoms  Physical and mental functioning  Clinical indicators

15.  Patient is engaged and demonstrates:  An understanding that ACTIONS determine health outcomes  Confidence to institute change

16.  Developed by Judith Hibbard and colleagues at the Univ. of Oregon  Valid and highly reliable survey tool that assesses patient activation and places patients into 1 of 4 stages of activation  Long form (22 items) and short form (13 items)  High scoring patients are significantly more likely to:  Perform self-management behaviors  Use self-management services  Report high medication adherence

17. 1. When all is said and done, I am the person who is responsible for taking care of my health. 2. I know what each of my prescribed medications do. 3. I am confident that I can follow through on medical treatments I may need to do at home. 4. I understand my health problems and what causes the.

18. Stage 1 Belief that an active role is important Stage 2 Building confidence and knowledge to take action Stage 3 Taking action Stage 4 Maintaining behaviors under stress

19.  Stage 1- Belief that an active role is important  Individuals do not feel confident enough to play an active role in their own health  Predisposed to be passive recipients of care  Stage 2 – Building confidence and knowledge to take action  Individuals lack confidence and an understanding of their health or recommended health regimen

20.  Stage 3 – Taking action  Individuals have the facts and are beginning to take action but may lack confidence and the skill to support their behaviors  Stage 4 – Maintaining behaviors under stress  New behaviors have been adopted but may not be able to be maintained under stress or health crises

21.  Center for Studying Healthcare Change 2007 Health Tracking Household Survey  Over 6500 respondents  Higher Activation  Younger  Higher education/income  Private insurance  White  No chronic conditions  Overall 78% in levels 3 or 4

22.  Higher engagement conditions  Asthma  Cancer  Diabetes  Lower engagement conditions  Depression  Heart Disease  Arthritis  Hypertension  Multiple conditions, smoking, obesity

23.  Can be useful in assessing an individual’s engagement and their willingness to learn and modify their behaviors  Used in research in conjunction with previously discussed outcome measures  Identify effective interventions

24.  Remember your audience  How do you reach?  Literacy level  Content must be personalized  KISS  Nothing can replace the interactions between patients and professionals

25.  Web based  Interactive modules  Self-monitoring tools  Phone based  Text reminders and education  Self-monitoring apps  Cable TV based  Home telehealth devices

26.  Institute for Interactive Patient Care (IIPC) www.instituteipc.org www.instituteipc.org  Organization dedicated to supporting research that evaluates interactive solutions that inform and engage patients  Funded studies on falls prevention and heart failure using an in-hospital solution

28. Patient Safety EXIT

30.  Patient population  Inclusion/exclusion criteria  Intervention  PAM  When to administer? How often?  Clinical outcomes